A smartphone app to reduce excessive alcohol consumption: Identifying the effectiveness of intervention components in a factorial randomised control trial Supplementary information Author details David Crane PhD1* [email protected] Claire Garnett PhD1,2* [email protected] Susan Michie DPhil1, [email protected] Robert West PhD3 [email protected] Jamie Brown PhD1, 2 [email protected] * joint first authorship Supplementary Table 1: Details of intervention modules Details of module BCTs Module Objective Enhanced Minimal Enhanced version Minimal version Normative feedback Inform users of the social Questions assessing how Text on risks of drinking Social comparison Information about drinking norm and alert users think they compare too much (from PHE health consequences them to any discrepancy with others. website) Provide normative information about with how they believe others’ behaviour and experiences Information about their drinking compares Infographics illustrating emotional with normal to how it how user’s drinking consequences actually compares with actually compares with normal. other adults and others of same gender and age. Cognitive bias re- Use a form of cognitive Game with all alcohol Game with 50% of None None training bias modification to related pictures alcohol related pictures strengthen cognitive associated with “avoid” associated with “avoid” control over the and all soft drink pictures and 50% associated with automatic biases to associated with “approach”. Same for approach alcohol that “approach”. soft drink pictures. predict alcohol use that exist amongst the users Additional section of text through an engaging on why and how this sort game. of game is believed to work. Details of module BCTs Module Objective Enhanced Minimal Enhanced version Minimal version Self-monitoring and Facilitate easy and on- Ability to record drinks, Ability to record drinks. Review behaviour goals, Discrepancy Self-monitoring of feedback going recording of graph showing units No other self-monitoring between current behaviour and goal, behaviour alcohol consumption; consumed calories facilitated. No feedback Feedback on behaviour, Self- provide feedback on consumed, amount spent provided monitoring of behaviour, Self- consumption, on alcohol. Record monitoring of outcomes of behaviour, consequences of mood, productivity, Feedback on outcomes of behaviour, consumption and clarity, sleep quality, Salience of consequences, progress toward goals. graph illustrating how Information about emotional they differ on mornings consequences, Social reward, Self- after heavy drinking reward compared to mornings after light/no drinking. Feedback on progress towards goals: cumulatively as the week progresses, on the past week and on all previous weeks. Action planning Allow users to create Create implementation Gain understanding of Action planning, None implementation intentions, review why to set intentions for dealing implementation implementation Credible source with difficult drinking intentions already intentions only. situations. created, gain understanding of why to set implementation intentions. Details of module BCTs Module Objective Enhanced Minimal Enhanced version Minimal version Identity change Help users foster a Memos – record Text on how identity is Identification of self as role model None change in their identity messages about drinking an important factor in so that users do not see or when drunk too much how we behave and Incompatible beliefs themselves as “drinkers” to watch in the future advise to think about the as a key part of their undesired consequences Valued self-identity identity which should aid “I am”: identifying and of drinking too much. their behaviour change considering those values attempt. that are important to you, Identity associated with changed and whether you do not behaviour live up to those values when you have drunk too Information about much. health/social/emotional consequences Flipsides of drinking: Salience of consequences Providing examples of Anticipated regret the negative sides of positive alcohol Pros and cons expectancies. Framing/reframing Supplementary Table 2: Experimental group matrix Self‐monitoring Action Normative Identity Cognitive Bias Group and Feedback Planning Feedback Change Re‐training 1 Enhanced Enhanced Enhanced Enhanced Enhanced 2 Enhanced Minimal Enhanced Enhanced Enhanced 3 Minimal Enhanced Enhanced Enhanced Enhanced 4 Minimal Minimal Enhanced Enhanced Enhanced 5 Enhanced Enhanced Enhanced Enhanced Minimal 6 Enhanced Minimal Enhanced Enhanced Minimal 7 Minimal Enhanced Enhanced Enhanced Minimal 8 Minimal Minimal Enhanced Enhanced Minimal 9 Enhanced Enhanced Enhanced Minimal Enhanced 10 Enhanced Minimal Enhanced Minimal Enhanced 11 Minimal Enhanced Enhanced Minimal Enhanced 12 Minimal Minimal Enhanced Minimal Enhanced 13 Enhanced Enhanced Enhanced Minimal Minimal 14 Enhanced Minimal Enhanced Minimal Minimal 15 Minimal Enhanced Enhanced Minimal Minimal 16 Minimal Minimal Enhanced Minimal Minimal 17 Enhanced Enhanced Minimal Enhanced Enhanced 18 Enhanced Minimal Minimal Enhanced Enhanced 19 Minimal Enhanced Minimal Enhanced Enhanced 20 Minimal Minimal Minimal Enhanced Enhanced 21 Enhanced Enhanced Minimal Enhanced Minimal 22 Enhanced Minimal Minimal Enhanced Minimal 23 Minimal Enhanced Minimal Enhanced Minimal 24 Minimal Minimal Minimal Enhanced Minimal 25 Enhanced Enhanced Minimal Minimal Enhanced 26 Enhanced Minimal Minimal Minimal Enhanced 27 Minimal Enhanced Minimal Minimal Enhanced 28 Minimal Minimal Minimal Minimal Enhanced 29 Enhanced Enhanced Minimal Minimal Minimal 30 Enhanced Minimal Minimal Minimal Minimal 31 Minimal Enhanced Minimal Minimal Minimal 32 Minimal Minimal Minimal Minimal Minimal E = Enhanced; M = minimal Supplementary Table 3: Full results of factorial ANOVA on primary outcome measure F P Normative Feedback (NF) 0.30 0.59 Cognitive Bias Re-training (CBR) 0.39 0.53 Identity Change (IC) 2.16 0.14 Self-monitoring and Feedback (SM) 0.78 0.38 Action Planning (AP) 0.14 0.71 NF x CBR 4.68 0.03 NF x IC 0.81 0.37 NF x SM 2.20 0.14 NF x AP 0.08 0.78 CBR x IC 0.94 0.33 CBR x SM 2.80 0.10 CBR x AP 0.01 0.93 IC x SM 0.39 0.54 IC x AP 0.04 0.84 SM x AP 0.22 0.64 NF x CBR x IC 1.86 0.17 NF x CBR x SM 0.03 0.87 NF x CBR x AP 4.94 0.03 NF x IC x SM 0.03 0.87 NF x IC x AP 0.29 0.59 NF x SM x AP 0.14 0.71 CBR x IC x SM 0.00 0.96 CBR x IC x AP 0.28 0.60 CBR x SM x AP 2.68 0.10 IC x SM x AP 0.52 0.47 NF x CBR x IC x SM 1.08 0.30 NF x CBR x IC x AP 0.01 0.93 NF x CBR x SM x AP 0.49 0.48 NF x IC x SM x AP 0.05 0.82 CBR x IC x SM x AP 0.85 0.36 NF x CBR x IC x SM x AP 0.12 0.73 Supplementary Table 4: Sensitivity analysis on primary outcome – main effects of intervention modules on change in past week alcohol consumption among responders- only Mean change in past week alcohol consumption, units per week (SD) Intensive Minimal F P Normative Feedback -14.1 (25.07) -14.6 (23.03) 0.12 0.73 Cognitive Bias Re-training -16.0 (23.73) -12.7 (24.47) 0.13 0.72 Action Planning -13.9 (20.87) -14.6 (26.92) 0.02 0.90 Self-monitoring & -14.8 (21.57) -13.7 (26.92) 0.05 0.82 Feedback Identity Change -10.8 (23.17) -18.2 (24.65) 4.26 0.04 Supplementary Table 5: Full results of factorial ANOVA on secondary outcomes– change in AUDIT score AUDIT score F P Normative Feedback (NF) 1.60 0.21 Cognitive Bias Re-training (CBR) 0.11 0.75 Identity Change (IC) 0.09 0.77 Self-monitoring and Feedback (SM) 0.35 0.56 Action Planning (AP) 1.75 0.19 NF x CBR 1.46 0.23 NF x IC 0.22 0.64 NF x SM 0.78 0.38 NF x AP 1.19 0.28 CBR x IC 0.28 0.60 CBR x SM 0.50 0.48 CBR x AP 1.60 0.21 IC x SM 0.46 0.50 IC x AP 2.34 0.13 SM x AP 5.82 0.02 NF x CBR x IC 0.01 0.91 NF x CBR x SM 0.03 0.86 NF x CBR x AP 0.07 0.79 NF x IC x SM 0.20 0.66 NF x IC x AP 0.03 0.86 NF x SM x AP 1.39 0.24 CBR x IC x SM 0.02 0.88 CBR x IC x AP 0.09 0.77 CBR x SM x AP 0.35 0.56 IC x SM x AP 0.54 0.46 NF x CBR x IC x SM 1.06 0.30 NF x CBR x IC x AP 1.99 0.16 NF x CBR x SM x AP 0.03 0.86 NF x IC x SM x AP 0.20 0.66 CBR x IC x SM x AP 0.54 0.46 NF x CBR x IC x SM x AP 0.31 0.58 Supplementary Table 6: Sensitivity analysis on secondary outcome – main effects of intervention modules on change in AUDIT score among responders-only Mean change in AUDIT score (SD) Intensive Minimal F P Normative Feedback -3.1 (4.34) -2.7 (4.77) 0.69 0.41 Cognitive Bias Re-training -3.2 (3.94) -2.6 (5.01) 0.28 0.60 Action Planning -3.5 (4.51) -2.3 (4.49) 2.67 0.11 Self-monitoring & -2.8 (4.41) -3.0 (4.70) 0.04 0.84 Feedback Identity Change -2.6 (4.72) -3.2 (4.31) 1.02 0.32 Supplementary Table 7: Full results table for secondary outcome measure – app usage Number of sessions Length per session F P F P Normative Feedback (NF) 1.64 0.20 1.64 0.20 Cognitive Bias Re-training (CBR) 0.05 0.82 0.05 0.82 Identity Change (IC) 0.86 0.36 0.86 0.36 Self-monitoring and Feedback (SM) 12.73 <0.001 12.73 <0.001 Action Planning (AP) 0.17 0.68 0.17 0.68 NF x CBR 0.40 0.53 0.40 0.53 NF x IC 2.33 0.13 2.33 0.13 NF x SM 0.92 0.34 0.92 0.34 NF x AP 2.49 0.12 2.49 0.12 CBR x IC 0.14 0.70 0.14 0.70 CBR x SM 0.24 0.62 0.24 0.62 CBR x AP 0.26 0.61 0.26 0.61 IC x SM 0.00 0.96 0.00 0.96 IC x AP 0.19 0.66 0.19 0.66 SM x AP 0.03 0.86 0.03 0.86 NF x CBR x IC 0.86 0.36 0.86 0.36 NF x CBR x SM <0.001 1.00 <0.001 1.00 NF x CBR x AP 0.12 0.73 0.12 0.73 NF x IC x SM 0.12 0.73 0.12 0.73 NF x IC x AP 0.28 0.60 0.28 0.60 NF x SM x AP 6.37 0.01 6.37 0.01 CBR x IC x SM 0.54 0.46 0.54 0.46 CBR x IC x AP 1.81 0.18 1.81 0.18 CBR x SM x AP 0.60 0.44 0.60 0.44 IC x SM x AP 2.93 0.09 2.93 0.09 NF x